国际麻醉学与复苏杂志   2017, Issue (7): 2-2
    
非先天性心脏病患儿气道环状软骨平面横径预测模型能否适用于先天性心脏病患儿
张侃, 陈华林, 陈怡绮, 郑吉建, 张马忠1()
1.上海交通大学医学院附属上海儿童医学中心
Can prediction model of tracheal diameter on cricoid plain derived from children without congenital heart disease be used in children with congenital heart disease?
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摘要：

目的　评价基于非先天性心脏病患儿（children without congenital heart disease, NCHD）气管环状软骨平面横径值（transverse diameter of cricoid cartilage, CD）与年龄或体型所建立的直线回归方程，比较回归方程预测先天性心脏病患儿（children with congenital heart disease, CHD）环状软骨平面的气管横径值（cricoid diameter predicted by formula, CDformula）和超声实测值（cricoid diameter measured by ultrasound, CDultra）的一致性。　方法　纳入64名NCHD，镇静后测量CDultra，记录患儿年龄、身高、体重、BMI、体表面积等数据，采用逐步向前法与CD建立线性回归模型。纳入CHD 30例和NCHD 25例，比较两组患儿CD超声测量值与线性回归模型预测值的一致性。　结果　NCHD的CD值与年龄呈正相关（r=0.90，P<0.05），回归方程为CD（cm）=0.048×年龄（岁）+0.525。两组人群CDformula和CDultra之间存在相关性（P<0.05），NCHD组患儿CDformula和CDultra的相关性为0.94，而CHD组患儿CDformula和CDultra的相关性为0.71。NCHD组和CHD组CDultra和CDformula的偏移值分别为-0.00 cm、-0.01 cm，95%一致性界限分别为（-0.06 cm，0.05 cm）和（-0.17 cm，0.15 cm），虽然两组患儿CDultra和CDformula的偏移相近，但是CHD组患儿的界限值宽于NCHD组患儿。　结论　在建立NCHD超声测量的CD值与年龄间线性回归方程的基础上，认为CHD模型预测和超声实测的一致性不如NCHD。因此在CHD气管插管时，测量CDultra可能会使气管导管的选择更加准确和便捷。
关键词： 超声；　声门下横径；　先天性心脏病；　儿童；　环状软骨
Abstract:

Ｏｂｊｅｃｔｉｖｅ　We evaluated the agreement of transverse diameters of cricoid cartilage(CD) of patients with congenital heart disease measured by ultrasound (CDultra) and the diameters that predicted by linear regression formula (CDformula), which was derived from pediatric patients without congenital heart disease(CHD).　Methods　After sedation, 64 pediatric patients without congenital heart disease (NCHD) were included to model the linear regression equation. CD measured by ultrasound, age, weight, height, body mass index and body surface area were recorded. After model established, 25 patients without CHD and 30 with CHD were included to evaluate the agreement of CD predicted by the linear regression with revised Bland-Altman analyses and CD measured by ultrasound.　Results　There was positive correlation between CD and age in children without CHD(r=0.90，P<0.05). Linear regression equation was CD (cm) = 0.048×age(year)+0.525. Bias in values of CDultra and CDformula were －0.00 cm and －0.01 cm. 95% limits of agreement was －0.06 cm to 0.05 cm and －0.17 cm to 0.15 cm individually. CDformula was correlated to CDultra in NCHD and CHD groups(0.94 and 0.71，P<0.05).　Conclusions　In our study, we show empirical formula from children without congenital heart disease cannot predict CD of children with CHD accurately. Thus, tracheal tube in pediatric patients guided by ultrasonography may be much more accurate and convenient.
Key words: Ultrasound;　Subglottic diameter;　Congenital heart disease;　Child;　Cricoid cartilage